36C25019B0019-013.docx
DOCX document Posted
- Attached to
- Replace Animal Research Facility Phase 3 - 539-327 Federal contract opportunity
- Solicitation number
- 36C25019B0019
About this file
This document contains a pre-solicitation notice and contractor evaluation form for a federal construction project. The Department of Veterans Affairs is seeking to add 22,000 square feet of wet labs and administrative spaces to Building 14 at the Cincinnati VA Medical Center. The project scope includes new finishes, plumbing, HVAC, electric, technology and security systems. Interested offerors must be classified as a small business and registered in relevant databases to be eligible for award under the 100% service-disabled veteran-owned small business set aside. The pre-award contractor evaluation form requests safety records and insurance information from prospective offerors. The solicitation is expected to be posted on October 16, 2019 with proposals due approximately 30 days later. The project value is estimated between $5-10 million under NAICS code 236220.
36C25019B0019 Contractor EMR Certification Form.docx
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Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Project 539-327:
Company Name: Address: Telephone: Fax: Email: Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations.
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
2. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 236220
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR):
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